Afghanistan: Little health care for women in Paktika province

"I will not take my wife to a male doctor even if she dies," said Pir Gul from Paktika Province, southeastern Afghanistan, explaining that such a thing went against tradition. Gul's mindset is common in Paktika Province where there is not a single female doctor, though the Central Statistics Office estimated Paktika's female population at over 180,000. "This is a very serious problem," Nangyalai (he only uses one name), the deputy director of Paktika's health department, told IRIN, adding that there were only a few female nurses and midwives in the whole province. With the help of aid organisations, the Ministry of Public Health (MoPH) increased the number of midwives in the country from 400 in 2001, to about 2,500 in 2008, but that is still not enough. "An estimated 4,546 midwives are needed to cover 90 percent of the country's pregnancies," the UN Children's Fund (UNICEF) said in its State of the World Children's report 2009. After Niger, Afghanistan has the second highest maternal mortality rate (MMR) in the world, and each pregnant Afghan faces a 1:8 risk of dying from complications, according to UNICEF. Challenges Limited access to maternal health care, poor awareness about safe delivery practices and scarcity of professional health workers are three factors contributing to the high MMR in Afghanistan, UNICEF says. Strong conservative traditions also hinder women's education and awareness in Paktika. "Societal norms require many women to be escorted outside the home by a male relative, thus restricting their mobility to access health facilities," the UNICEF report said. MoPH officials in Kabul said they were committed to expanding basic health services country-wide, but "insecurity is the biggest problem impeding the work of female health workers," Deputy Health Minister Faizullah Kakar told IRIN. Amateur midwives No one has reliable figures on maternal and infant mortality rates in Paktika where deaths mostly result from preventable and curable diseases, aid workers say. In the absence of professional health personnel, women seek treatment and medical care from amateur midwives and herbal medicines. "Usually an elderly woman in a village attends during delivery," said Rozi Khan, a local resident. Many women are feared to be suffering, and even dying, from post-delivery infections due to poor hygiene and lack of access to antibiotics, experts said. Women and young girls with other diseases have little or no option but to endure pain and inconvenience until a natural recovery is achieved. Some use locally produced herbal medicines, while others seek advice and help from local drug sellers. In extreme cases and when an illness is prolonged, those who can afford to, take a sick female to Kabul or Pakistan for medical treatment.